Unknown Individual – Nurse Practitioner, NPI 1720085558

Nurse Practitioner

Unknown Individual is a healthcare provider. based in Farmington, Connecticut. specializing in Nurse Practitioner. They hold a License No. 31463 (CT). The NPI Number for Unknown Individual is 1720085558

Main info

Organization

Inactive

25 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1720085558

Phone

(860) 679-3343

Address

263 FARMINGTON AVE

Deactivation Date

29 November 2023

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8606797503

Graduation Year

2001 (25 years ago)

PAC ID

7113096736

Group Practice PAC ID

3678472016

Professional Enrollment ID

I20080521000697

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

University of Connecticut Health Center, 263, Farmington Avenue, Farmington, Hartford County, Connecticut, 06030, United States
FARMINGTON, CT 060300001
Phone: (860) 679-3343
Fax: (860) 679-4256
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06030)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 3678472016View full group profile

Name	Specialty	State
MR. IAN THOMAS MCNEILL	N E U R O S U R G E R Y	NY
TARUNYA REDDY VEDERE	E N D O C R I N O L O G Y	VA
DR. ISAAC MOSS (M.D.)	Orthopedic Surgery	CT
DR. MICHAEL CHRISTOPHER SOBIERAJ (MD, PHD)	Orthopedic Surgery	CT
BEATRIZ R ESAYAG-TENDLER (MD)	Endocrinology, Internal Medicine	CT
YASSER A AL-BAGHDADI (M.D.)	Critical Care (Intensivists)	CT
SHOBHANA PATHANI (MD)	Hospitalist, Internal Medicine	CT
DR. JENNIFER ROSE JORGENSEN (MD)	Gynecological Oncology	NY
ALEXANDRA SHAW (PA-C)	Physician Assistant	CT
CRAIG M RODNER (MD)	Hand Surgery, Orthopedic Surgery	CT

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?

Unknown Individual — NPI 1720085558 — is the standard way to identify this listing.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.

Does Unknown Individual list a practice location?

Patients near Farmington, Connecticut may find Unknown Individual in results; validate coverage separately.

How many locations tie to this NPI?

2 practice locations appear in the available data.

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